PB2368: THE PRE-EMPTIVE STRATEGY OF HEPATITIS B VIRAL REACTIVATION IN PATIENTS WITH MALIGNANT HEMOPATHIES RECEIVING IMMUNSUPPRESSIVE THERAPY IN TUNISIA
Authors: Miled Wafa, Dorra Jabeur, Raoudha Mansouri, Malek Sayedi, Karima Kacem, Raihane Ben Lakhal
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Hepatitis B represents a major public health problem because of its high morbidity and mortality rates. In Tunisia, through the vaccination protocol and campaigns, it became a low endemic region for hepatitis B (HBV). However, patients with hematologic malignancies remain at high risk of infection and HBV reactivation due to Rituximab. This treatment represents the cornerstone of therapeutic management in hematology. HBV reactivation remains a fatal complication which can be prevented by a well-respected preemptive therapy. Aims: The aim of our study was to analyze how well the preventive strategy of hepatitis B reactivation was followed in hematology with patients receiving Rituximab in Tunisia? Methods: We performed a retrospective, descriptive study involving patients with B lymphoid hemopathies treated, in the clinical hematology department of Aziza Othmana Hospital, in Tunisia between 2013 and 2019. All the patients had a hepatitis B serologic testing at diagnosis and received an immunosuppressive therapy containing rituximab. HBV serologic testing included at least one of the serological markers: HBsAg, Anti HBc, Anti HBs. Results: Two hundred and thirty patients were included. The median age was 52 years with a sex ratio of 1.32. Eighty-six per cent of patients (n=199) had a non-hodgkin lymphoma and 14% had chronic lymphocytic leukemia. One hundred and ninety four patients (84%) had a complete serological testing as fellow: 136 patients had negative serology, 43 had a resolved infection profile, 9 were immune due to vaccination, 5 patients had chronic hepatitis B and one had an acute hepatitis B. Thirty six patients (16%) had an incomplete serologic testing limited to one of the marquers mentionned above. The prevalence of HbsAg was 3.47%. Twenty-one per cent of patients (n=49) had a contact with HBV and a complete serological profile at diagnosis, among these patients: 43 had a resolved infection, 5 had a chronic hepatitis B and one had acute hepatitis B. The HBV DNA viral load was requested in 36,8%. A consultation with gastro enterologists was required in 91.8%. A preemptive therapy was indicated in 63.6% and curative treatment in 6% of cases. Rituximab was received with delay in 57% of cases: the major causes were the waiting for serology results and gastroenterologists’ opinions. Four cases of HBV reactivation occurred: two patients were on continuous preemptive therapy at the time of reactivation. Summary/Conclusion: The prevalence of HbsAg with hematology patients is comparable to the general population. The clinicians are aware of the importance of a complete serological testing and the cooperation between hematologists and gastro enterologists. However, the prescription of preemptive treatment remains insufficient. Late HBV reactivations were observed and indicated a longer duration of preemptive treatment. Keywords: Lymphoid malignancy, Hepatitis B virus, Lymphoma, Immunosuppressive therapy